‫الر ِح ْي ِم‬

َّ ‫الر ْح َم ِن‬
َّ ِ ‫ب ِ ْســــــــــــــــــ ِم هللا‬

Dry Eye
(Keratoconjungtivitis Sicca)
By Munifatuzzahrah
19360201

Preceptor
dr. Rahmat Syuhada, Sp.M
Universitas Malahayati
Universitas Malahayati
Anatomy and physiology
Four processes tears pass
through, namely the production of an
apparatus or system lacrimal secretory,
distribution by blinking, evaporation of
the ocular surface, and drainage through
the lacrimal excretory apparatus. The
lacrimal system consists of 2 systems,
namely:
1. Secretion system
2. Excretion system
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Secreting System

The lacrimal gland

secretion system consists of the
main lacrimal gland, lacrimal
gland accessory namely the
Krausse and Wolfring gland,
sebaceous gland palpebra or
Meibom gland, and goblet cells of
the conjunctiva in the form of
musin.
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Excretion System
The excretion component consists of
punktum lacrimal, lacrimal canaliculus,
lacrimal saccus, ductus nationalolakrimalis,
and inferior nasi meats. Every blinking, the
palpebra closes like a zipper starting from the
lateral, spreading water eyes evenly over the
cornea and channel them into the excretion
system at medial side of the palpebra. Under
normal circumstances, tears are produced at
speed which corresponds to the amount
evaporated. Therefore, only a few get to the
excretion system
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Tear Layer Composition

Pre-corneal tear film
-Superficial thin lipid layer
-Middle bulk aqueous layer
-Innermost mucous layer
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Lipid layer

Lipid layer is secreted by the meibomian glands & gland

of Zeiss.
Their function is:
 To reduce the evaporation of the aqueous layer.
 To increase the surface tention& asist in vertical
stability of the tear film
 To lubricate the eyelids.
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Aqueous layer

The middle layer is secreted by lacrimal gland & has

following functions:
 To supply atmospheric oxygen to the avascular
corneal epithelium
 Anti –bacterail function
 To reduce the irregularities of anterior corneal surface
 To clean away the debris.
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Mucin layer

The inner layer is secreted by the conjunctiva goblet

cells, crypts of Henle & glands of Manz .
 It converts the corneal
 epithelium from hydrophobic
 to hydrophilic state
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Normal tear film

 Volume : 7-10 μ l , avoid blinking 20-30 μ l

 Thickness : 7microns
 Production : 1.2 μ l/min (0.5-2.2)
 Turn over : 16%
 Tear evaporation (0.14 μl/min in 30% humidity)
 pH : 6.5-7.6
 Surface tension : 40.7 dyne/cm
 Refractive index : 1.336
 Osmolarity : 300-310 mOsm/l
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Healthy tears

A complex mixture of proteins, mucin, and electrolytes

 Antimicrobial proteins: Lysozyme, lactoferrin
 Growth factors & suppressors of inflammation: EGF,
IL-1RA
 Soluble mucin 5AC secreted by goblet cells for
viscosity
 Electrolytes for proper osmolarity
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Tear Function

1. Maintain moisture in the cornea

and conjunctiva
2. Supply oxygen to the corneal
epithelium
3. Wash debris funds for irritant
ingredients
4. Prevent infection through anti-
bacterial substances
5. Facilitating palpebral movement in
the eyeball
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Dry Eye
Dry eye syndrome (keratoconjungivitis sicca) is a
condition where the tears are abnormal and cannot
lubricate (lubricate) the surface of the front of the cornea.
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Dry Eye Syndrome Classification

According to DEWS
(2007), Vocational Schools can be
categorized as Aquoeus deficient
and evaporative dry eye.
Aqueous tear deficient dry
eye is a group of dry eyes caused
by a lack of tear production even
though the evaporation is still
normal
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Risk Factor
1. advanced age
2. hormonal
3. Medications can reduce tear production such as antidepressants,
decongestants, antihistamines, antihypertensive
4. Users of eye contact lenses, especially soft contact lenses
5. Environmental factors such as hot and dry air, smoke, air pollution,
wind, continuous air-conditioned room will increase tear evaporation
6. Eyes that stare continuously so they forget to blink
7. Patients who have undergone refractive surgery such as
photorefractive keratectomy (PRK), laser-assited in situ keratomileusis
(LASIK) will experience a temporary dry eye.
 Aging

The most common cause of severe dry eye is aging.

Aging is directly associated with a reduction in lipid
production, resulting in evaporative dry eye.
Over time your body produces less oil- 60% less at age
65 than at age 18.
The incidence of severe dry eyes over the age of 65 is
around 75%.
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Schematic Degree of Dry Eye Weight

Dry Eye Severity 1 2 3 4

Mild and / or Moderate

Inconvenience, episodic; occurs (moderate), Weight and Tight (severe) and / or
severity, and due to episodic or often or constant very disturbing and
frequency environmental chronic, stressed without tress constant
stress or not stressed
Not
Chronically
experiencing or Interfering with
disturbing and / Constant and / or very
Visual symptoms experiencing / or limiting
or constant, disturbing
mild episodic episodic activity
limiting activity
fatigue
Conjunctival
Nothing to light Nothing to light +/- +/++
injection
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Dry Eye Symptoms

The symptoms of dry eye can be:
1. Pain in the eyeball
2. The surface of the eyeball feels like sand, as if something is
blocking the surface of the eyeball.
3. Watery eyes after a period where the eyes feel very dry.
4. Rub.
5. Pain and red eyes.
6. Blurred vision.
7. The eyelids feel heavy.
8. Inability to shed tears when crying.
9. Feel uncomfortable when using contact lenses.
10. Decreasing reading tolerance, working using a computer, or any
activity that requires continuous visual attention.
11. Eye fatigue.
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Diagnosis
Other special tests are important to assess the
function of tears in quality and quantity such as :
1. Schirmer’s Test
2. Tear Break-Up Time (TBUT)
3. Coloring
4. Ferning Test
5. Impression Cytology
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Management
Types of Therapy Treatment
 Environmental education and modification
Environment / Exogenous
 Eliminating the effects of topical or systemic treatment
 Artificial tears (Artificial tears), gel / ointment
Topical treatment
 Anti-inflammatory (cyclosporine and topical corticosteroids
 Mucolytic agent
 Autologous serum
 Omega 3 fatty acids (can increase the risk of prostate cancer in men
Systemic Medicine
 Tetracycline (for meibomian gland dysfunction, rosacea)
 Systemic anti-inflammation
 secretagogues
 Installation of punktum plugs
Surgery
 Permanent installation of punktum plugs
 Stitching one third of the eyelids (tarsoraphy)
 Repair of eyelid positioning
 Lender membrane, salivary gland, and grafting of the amniotic membrane.
 Therapy on the eyelids (compress warm water
OthersOthers
 Lens contact
 Glasses moisture chamber
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Thanks You
Everybody